A Comparative Study of MiniMental State Exam and the Saint Louis University Mental Status for Detect - PowerPoint PPT Presentation

Loading...

PPT – A Comparative Study of MiniMental State Exam and the Saint Louis University Mental Status for Detect PowerPoint presentation | free to view - id: 4babd-M2E5Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

A Comparative Study of MiniMental State Exam and the Saint Louis University Mental Status for Detect

Description:

... more sensitive than the Mini-Mental State Exam (MMSE) in mild cognitive screening. ... norms for the Mini-Mental State Examination by age and educational ... – PowerPoint PPT presentation

Number of Views:193
Avg rating:3.0/5.0
Slides: 2
Provided by: jimne5
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: A Comparative Study of MiniMental State Exam and the Saint Louis University Mental Status for Detect


1
A Comparative Study of Mini-Mental State Exam and
the Saint Louis University Mental Status for
Detecting Mild Cognitive Impairment Among Eye
Care Patients Patricia C. Heyn, Ph.D.1, Tammie
Nakamura, M.S.1, Rosa Tang, M.D., M.P.H.2,
Mukaila Raji, M.D.,MSc.2, Young-Fang Kuo,
Ph.D.2 1Division of Geriatric Medicine The
University of Colorado Health Sciences Center
Denver, Colorado 2 School of Medicine The
University of Texas Medical Branch Galveston,
Texas
INTRODUCTION Aging is one of the major factors
for cognitive dysfunction. The combination of an
aging population and the promise of
disease-modifying therapies for Alzheimers
Disease (AD), inspire the dementia research field
to seek screening approaches to identify the
early stages of AD. Although screening
instruments for cognitive impairment (CI) are
frequently used in the elderly, the concept of
mild cognitive impairment (MCI) is aimed to
capture patients in the transition from normality
to dementia. If MCI is identified patients could
be informed about options for intervention and
treatment that could delay the progression of
this syndrome. The World Health Organization
identifies visual impairment (VI) as one of the
major reasons for disability in the elderly. VI
directly and indirectly affects the health of the
elderly. It was reported that 1.668 million
British adults were disabled by defective vision
in 19881. Cataract was the most common cause of
disability and blindness. Recent studies are
supporting a cause-and-effect association between
type of severity of visual loss and the major
causes of dementia 2-3. A key public health
strategy to reduce disease burden and slow down
disability processes in the elderly is early
screening for potentially treatable health
factors at specific target sites, such as the Eye
Clinic. Older adults visit the ophthalmology
clinic more often than other health-care
specialties (Table 1). STUDY
PURPOSE To examine the Saint Louis University
Mental Status (SLUMS) examination as a screen for
MCI and to test if the SLUMS is more sensitive
than the Mini-Mental State Exam (MMSE) in mild
cognitive screening. The SLUMS like the MMSE is
a11-item scale with scores ranging from 0-30,
with lower scores indicating increasing severity
of CI in the domains of orientation,memory,
attention, language executive
function. METHODS 100 patients age 60 and older
attending the University of Texas Medical Branch
(UTMB) Eye Clinic were consented to participate.
Study was approved by the UTMB IRB. After
educational adjustments4, 60 of the sample
scored in the CI range of the SLUMS but not on
the MMSE. African American and Hispanics
presented more CI compared to white patients as
defined by the SLUMS (OR, 2.80 95
CI,1.05-7.44), independent of age, years of
education and chronic diseases.
  • RESULTS
  • Mental status screening by the St Louis Mental
    Status Examination (SLUMS) showed that 65 pts
    scored for cognitive impairment (CI), 46 for mild
    CI, and 19 for severe CI (Fig.1).
  • Significant Correlations were found between the
    SLUMS and MMSE domains (Table 3).
  • Pts w/ diabetes were more likely to have CI
    (81.6) diabetics versus 54.8 in non-diabetics,
    p0.006.
  • Diabetes was significantly predictive of CI
    (OR,3.28).
  • No significant association between VI CI
    (p0.06).
  • Cataracts was the most common eye disease.
  • on this sample (Table 4).


Table 2. Sample Characteristics (N 100)
Value Age, mean SD 68.48.1 Men
42.0 White 61.0 African
American, 22.0 Hispanic, 16.0 Income
(gt20,000 ) 33.3 Education (gthigh
school) 36.0 Living Alone 35.0 Currently
Married 60.0 Currently Taking Medications
89.0 Chronic Disease History
92.0 (Diabetes, Hypertension, Stroke, CAD,
Cancer, etc) Eye Disease 87.0 BMI gt 25
74.7 Systolic Blood Pressure gt135mmHG
68.4 MMSE, mean SD 27.53.7 SLUMS, mean
SD 21.8 5.5
Table 1. The National Ambulatory Medical Survey
ophthalmology ranked as the second most visited
specialty by patients 65 yrs and older.
Figure 3. MMSE SLUMS Domains Demographic
Comparisons
Figure 1. Frequency of cognitive impairment using
the St. Louis University Mental Status
Examination Scale (SLUMS), N100 (adjusted by
education levels).
  • LIMITATIONS
  • Limited associations between vision and
    cognition function due to the small number of
    participants.
  • Inferences between ethnicity, chronic disease
    status, and CI variables are limited due to the
    cross sectional design.
  • Potential bias from recruiting participants from
    one site Eye clinic site.
  • Lack of confirmatory diagnostic exam for CI.
  • TAKE HOME MESSAGE
  • Despite the small sample and sampling procedures
    limitations,
  • these findings do support the need to further
    determine the association between cognitive
    function and disease development in visually
    impaired elders.
  • The results suggest that the SLUMS is more
    sensitive to detect MCI than the MMSE.
  • 65 of participants 60 yrs and older attending
    the UTMB Eye Clinic screened positive for CI on
    the SLUMS.
  • African American Hispanics adults (non-whites)
    and participants with diabetes were significantly
    more likely to present CI.
  • Early screening for CI might slow down the
    progression of cognitive decline and disability
    in the ophthalmic elderly patient.
  • The Eye Clinic seems to be a feasible site for
    health screening and it could be a valuable and
    low cost strategy to detect elderly at risk for
    developing dementia.
  • Further research is needed to assess the effects
    of interventions on the progression of CI and
    diabetes.
  • Results should be cross-validated on a larger
    sample.

Figure 2. Canonical Discriminate Function
(X248.6,18df,plt0.0001 74 variance explained by
scale, 26 with significant loadings for SLUMS
domains - Registration Recall, Attention,
Calculation, Executive Function, Language
REFERENCES 1. Congdon NG, Friedman DS, Lietman
TL. (2003). Important causes of visual impairment
in the world today. JAMA(290)2057-60 2. Duffy
C.J. (1999). Visual loss in Alzheimers disease.
Neurology 5210-11. 3. Giannakopoulos P. et al
(1999). Neuroanatomic correlates of visual
agnosia in Alzheimers disease a
clinicopathologic study. Neurology 5271-77. 4.
Crum RM, Anthony JC, Bassett SS, Folstein MF..
Population-based norms for the Mini-Mental State
Examination by age and educational level .JAMA.
1993 May 12 269(18)2386-91.
Acknowledgments Dr.Heyn is supported by the
National Institute on Aging, Trainee Grant in
Geriatric Research NIH/NIA ST 60877. Ms.
Nakamura is supported by the NIH R01 AG0193398.
This study was also supported by the Galveston
Jamail Foundation. The authors thank the
developers of the Saint Louis University Mental
Status Examination (SLUMS) instrument for
allowing the use of their instrument.
About PowerShow.com